Method and apparatus for the stabilization of the trapeziometacarpal joint

ABSTRACT

A method and apparatus for the stabilization of the trapeziometacarpal joint following the removal or partial resection of the trapezium includes an assembly for securing a first metacarpal relative to a second metacarpal. The assembly includes a suture guide having a suture anchor plate that is frangibly connected to a guide stem.

This application claims priority to, and is a divisional application of,U.S. patent application Ser. No. 13/216,550, which was filed on Aug. 24,2011 and is expressly incorporated herein by reference.

BACKGROUND

The present invention relates generally to surgical repair of thetrapeziometacarpal joint. More specifically, the present inventionrelates to a method and apparatus for the stabilization of thetrapeziometacarpal joint following the removal or partial resection ofthe trapezium.

The trapezium is connected to the first metacarpal bone of the thumb andsupports movement of the thumb relative to the remainder of the hand.This joint is susceptible to osteoarthritis that results in significantdegradation of the use of the thumb in opposition to the fingers.Gripping becomes extremely painful.

Treatment of arthritis of the trapeziometacarpal joint includes jointarthroplasty, arthrodesis, and arthroscopic debridement among others.When arthroplasty is employed, recovery is aided by the properpositioning of the joint, and specifically the maintenance of therelationship between the first and second metacarpal bones duringhealing of the joint.

The use of sutures or other tethers to fix the position of onemetacarpal relative to the other is known in the art. A securing tetheris passed through a passageway formed through the cortex of adjacentmetacarpals and is then secured to a plate positioned against the cortexof the metacarpal and cinched to secure the position of a firstmetacarpal relative to a second metacarpal. In some situations, thetether must be positioned in the plate during the surgical procedureafter the tether has passed through the passageway. This approach mayresult in the tether being soiled by fluids and tissues present in thesurgical site, thereby hindering the ability of the surgeon to positionthe tether in engagement with the plates.

SUMMARY

The present application discloses one or more of the features recited inthe appended claims and/or the following features which alone or in anycombination, may comprise patentable subject matter.

According to a first aspect of the present disclosure, a method forcarpometacarpal fixation may include positioning a drill guide byadvancing the drill guide from the dorsal-ulnar aspect of the secondmetacarpal to the base of the first metacarpal. The method also mayinclude advancing, radial to ulnar, a cannulated drill over the drillguide. The method further may include removing the drill guide. Themethod still further may include advancing a suture guide through thecannulated drill, radial to ulnar. The method yet further may includeinserting a suture into the suture guide. The method still further mayinclude withdrawing the suture guide such that suture material isexposed on both the ulnar side of the second metacarpal and the radialside of the first metacarpal. The method also yet further may includefixing the suture to stabilize the relation between the first and secondmetacarpals.

In some embodiments, the method may also include positioning a secondanchor plate to seat against the second metacarpal. The method mayinclude positioning a first anchor plate to seat against the secondmetacarpal. The method may yet further include separating the firstanchor plate from the suture guide.

The method may still further include positioning the suture such that asecond suture loop engages the first anchor plate and the free ends ofthe suture are accessible at the radial side of the second metacarpal.

The method may still yet further include reducing the distance betweenthe second metacarpal and the first metacarpal by reducing an operablelength of the suture by pulling on second and second free ends of thesuture. The method may also include positioning the suture such that asecond suture loop engages the second anchor plate.

In some embodiments, the method may include removing the cannulateddrill.

According to another aspect of the present disclosure, a method forcarpometacarpal fixation may include positioning a drill guide byadvancing the drill guide from the ulnar side of the second metacarpalto the base of the first metacarpal. The method may also includeadvancing a cannulated drill bit over the drill guide in a radial toulnar direction. The method may include removing the drill bit. Themethod may still further include advancing a cannula over the drillguide through the first and second metacarpals in a radial to ulnardirection. The method may still further include removing the drillguide. The method may also further include advancing a suture guidethrough the cannula in a radial to ulnar direction. The method may alsoinclude inserting a suture into the suture guide. The method may stillinclude fixing the suture to stabilize the relation between the firstand second metacarpals.

The method may further include positioning a first anchor plate to seatagainst the first metacarpal. The method may also include positioning asecond anchor plate to seat against the second metacarpal. The methodmay still also include separating the second anchor plate from thesuture guide.

In some embodiments, the method may include positioning a first anchorplate to seat against the first metacarpal. The method may also includepositioning the suture such that a first suture loop engages the firstanchor plate and the free ends of the suture are accessible at the ulnarside of the second metacarpal.

In some embodiments, the method may include reducing the distancebetween the first metacarpal and the second metacarpal by reducing anoperable length of the suture by pulling on the first and second freeends of the suture.

The method may also include positioning the suture such that a secondsuture loop engages the second anchor plate.

The method may still further include removing the cannula.

According to yet another aspect of the present disclosure, an assemblyfor carpometacarpal fixation may include a suture guide. The sutureguide may include a stem and a first anchor plate frangibly secured tothe stem. The first anchor plate may include a body and a plurality ofthrough holes formed in the body. The assembly may further includesecond anchor plate. The second anchor plate may include a plurality ofthrough holes formed in the second anchor plate. The assembly may stillalso include a tether engaged with the second anchor plate and the firstanchor plate.

In some embodiments, the tether is adjustable to vary the distancebetween the anchor plates.

The tether may include a first loop that is engaged with the secondanchor plate with the first loop extending through a first of theplurality of through holes in the second anchor plate over a portion ofthe second anchor plate and through a second of the plurality of throughholes in the second anchor plate.

The tether may also include a second loop that is engaged with the firstanchor plate with the second loop extending through a first of theplurality of through holes in the first anchor plate over a portion ofthe first anchor plate and through a second of the plurality of throughholes in the first anchor plate.

In some embodiments, the tether may include a third loop that is engagedwith the second anchor plate with the third loop extending through afirst of the plurality of through holes in the second anchor plate overa portion of the second anchor plate and through a second of theplurality of through holes in the second anchor plate. The first anchorplate may comprise an oblong plate and the second anchor plate maycomprise a round plate in some embodiments.

Additional features and advantages of the invention will become apparentto those skilled in the art upon consideration of the following detaileddescription of illustrated embodiments exemplifying the best mode ofcarrying out the invention as presently perceived.

BRIEF DESCRIPTION OF THE DRAWINGS

The detailed description of the drawings particularly refers to theaccompanying figures in which:

FIG. 1 is a diagrammatic representation of the bone structure of thehuman hand;

FIG. 2 is a perspective view of an assembly for fixation of acarpometacarpal relationship;

FIG. 3 is a perspective view of a first anchor plate of the assembly ofFIG. 2;

FIG. 4 is a perspective view of a second anchor plate of the assembly ofFIG. 2;

FIG. 5 is a perspective view of a suture guide of the assembly of FIG.2;

FIG. 6 is a diagrammatic view of a portion of the skeletal hand with adrill guide inserted through the first and second metacarpals;

FIG. 7 is a diagrammatic view similar to FIG. 6, FIG. 7 including acannulated drill bill advanced over the drill guide;

FIG. 8 is a diagrammatic view similar to FIG. 7, the hand of FIG. 8having a cannula positioned through the first and second metacarpals;

FIG. 9 is a diagrammatic view of a portion of a skeletal hand with astem of the suture guide of FIG. 5 positioned in the cannula of FIG. 8;

FIG. 10 is a diagrammatic view with the assembly of FIG. 2 placed on thehand such that the suture guide is positioned on the ulnar side of thesecond metacarpal and the first anchor plate is positioned on the radialside of the first metacarpal;

FIG. 11 is a diagrammatic view similar to FIG. 10, the second plateseparated from the stem of the suture guide and the assembly secured tofix the position of the first metacarpal relative to the secondmetacarpal;

FIG. 12 is a diagrammatic view similar to FIG. 7, the stem of the sutureguide of FIG. 5 positioned in the cannulated drill;

FIG. 13 is a diagrammatic view similar to FIG. 12, the cannulated drillremoved from the hand and the suture guide advanced through a passagewayformed in two metacarpals so that the first plate is positioned on theulnar side of the second metacarpal; and

FIG. 14 is a diagrammatic view similar to FIG. 11, the first plate ofthe assembly positioned on the ulnar side of the second metacarpal, thesecond plate separated from the stem of the suture guide, and theassembly secured to fix the position of the first metacarpal relative tothe second metacarpal.

DETAILED DESCRIPTION OF THE DRAWINGS

As shown in FIG. 1, in a human hand 10, the first metacarpal 12 (of thethumb) engages the trapezium 14, which is a carpal bone structure. Thefirst metacarpal 12 is positioned on the medial side of the hand 10 ingeneral alignment with the radius 16. The carpal bones 18 are supportedby the radius 16 and the ulna 20. For purposes of this discussion,reference to the term “ulnar” will refer to the side 22 of the hand 10that engages the ulna and “radial” will refer to the side 24 of the hand10 that engages the radius. The reference to sides and directions arefor orientation in understanding the procedures described below.

The present application discloses a method and apparatus for fixation ofthe first metacarpal 12 relative to the trapezium 14 by using anassembly 28 (shown in FIG. 2) to secure the first metacarpal 12 relativeto the second metacarpal 26. Referring to FIG. 2, the assembly 28includes a first anchor plate 34 that may be seated against the cortexof one of the metacarpals when the assembly 28 is installed. Theassembly 28 also includes a tether 32, illustratively embodied as asuture material, which secures the first anchor plate 34 to a secondanchor plate 30 that may be positioned against the cortex of a secondmetacarpal with the tether 32 extending between the metacarpals tomaintain the spacing between the metacarpals or stabilize the metacarpalfollowing removal or partial resection of the trapezium.

As shown in FIG. 4, the first anchor plate 34 has a generally oblongbody 41 with two through holes 40 and 42 formed in the first anchorplate 34. In the illustrative embodiment, the first anchor plate 34comprises a titanium alloy, Ti-6AL-4V. It should be understood thatother titanium alloys or other materials might be used to form the firstanchor plate 34 as well.

As shown in FIG. 3, the second anchor plate 30 has a generally circularor round shape with two through holes 36 and 38 formed in the secondanchor plate 30. In the illustrative embodiment, the second anchor plate30 comprises a titanium alloy, Ti-6AL-4V. It should be understood thatother titanium alloys or other materials might be used to form thesecond anchor plate 30 as well.

Referring now to FIG. 5, a suture guide 44 includes a stem 46 with thesecond anchor plate 34 connected to the stem 46 through a frangibleconnection 48 which is configured to permit the second anchor plate 34to be manually separated from the stem 46.

The assembly 28 is used to stabilize the first metacarpal 12 followingpartial or complete excision of the trapezium, whether excision of thetrapezium is performed in an open or arthroscopic procedure. Theassembly 28 may be used in conjunction with or without a biologicreconstruction of the ligament 90 at the base of the first metacarpal 12to repair carpometacarpal arthritis or instability as preferred by thesurgeon.

In one approach, the assembly 28 is positioned with a knot 76 securingthe second anchor plate 34 on the ulnar side 22 of the second metacarpal26 as shown in FIG. 11. The procedure includes advancing a1.3-millimeter Kirschner wire 64 from the dorsal-ulnar aspect of thesecond metacarpal 26 to an exit point 58 at the base of the firstmetacarpal 12 as shown in FIG. 6. The Kirschner wire is drivenapproximately 3 centimeters beyond the cortex of the cortex of the firstmetacarpal 12. The Kirschner wire 64 is positioned under fluoroscopywith the exit point 58 positioned about 5-10 millimeters distal from thebasal joint surface. The Kirschner wire is centrally positioned in thesagittal plane of each of the first metacarpal 12 and second metacarpal26. Once the Kirschner wire 64 is placed, the exit point 58 is exposedwith a 7-10 millimeter incision and blunt dissection to expose thecortex of the first metacarpal 12.

Referring now to FIG. 7, a 2.7 millimeter cannulated drill bit 66 ispositioned over the Kirschner wire 64 on the radial side 24 of the firstmetacarpal 12 and driven radial to ulnar, exiting the ulnar cortex 68 ofthe second metacarpal 26 as shown in FIG. 7. Referring now to FIG. 8,the drill bit 66 is withdrawn, with the Kirschner wire 64 remaining inposition. A cannula embodied as a PTFE tube 70 is advanced over theKirschner wire 64 through the first metacarpal 12 and the secondmetacarpal 26 as shown in FIG. 8. Referring now to FIG. 9, the Kirschnerwire 64 is removed and the stem 46 of the suture guide 44 is advancedthrough the tube 70 radial to ulnar with the suture 32 positionedthrough the through holes 36 and 38 of the first plate 30. It should beunderstood that in some embodiments, the suture guide 44 could beadvanced through the tube 70 in an ulnar to radial direction. Two loops71 and 72 engage the first anchor plate 30 and two free ends 74 and 75positioned in the holes 40 and 42 of the second anchor plate 34. A loop77 passes over the body 41 of the second plate 34.

Once the suture guide 44 has been advance through the tube 70, the tube70 is removed from the ulnar side 22 as shown in FIG. 10. The firstanchor plate 30 is then positioned to seat against the first metacarpal12. The stem 46 of the suture guide 44 is manually removed from thesecond anchor plate 34 by snapping the frangible connection 48 anddiscarding the stem 46. The first anchor plate 30 is positioned againstthe cortex of the first metacarpal 12 and the second anchor plate 34 ispositioned against the cortex of the second metacarpal 26 withoutimpinging on any other tissues. The suture 32 is tensioned byalternately pulling each strand is small increments until the desiredreduced position of the first metacarpal 12 is achieved. The secondanchor plate 34 is then secured with a multiple surgeon's knot 76 asshown in FIG. 11.

Following closure of the surgical sites, the joint is splinted. Afterone week, the splint, dressings, and sutures are removed and the firstmetacarpal 12 is splinted with a molded splint in a slightly abductedposition. The splint is discontinued at four weeks post operative andprogressive physical therapy is employed.

In another approach, a knot 78 is positioned on the radial side 24 ofthe first metacarpal 12 as shown in FIG. 14. In this approach, prior toremoval of the cannulated drill bit 70, the Kirschner wire 64 is removedand the stem 46 of the suture guide 44 is then inserted through thecannula of the drill bit 70 from the ulnar side 22 as shown in FIG. 12.The cannulated drill bit 70 is then removed from the radial side 24 withthe stem 46 in place. The suture 32 positioned through the through holes36 and 38 of the first plate 30. Two loops 71 and 72 engage the firstanchor plate 30 and two free ends 74 and 75 positioned in the holes 40and 42 of the second anchor plate 34. A loop 77 passes over the body 41of the second plate 34.

Once the cannulated drill bit 80 is removed, the suture guide 44 is thenadvanced such that the second anchor plate 34 exits the radial side 24of the cortex of the first metacarpal 12. The second anchor plate 34 ispositioned on the ulnar side 22 of the cortex of the second metacarpal26. The stem 46 of the suture guide 44 is manually removed from thesecond anchor plate 34 by snapping the frangible connection 48 anddiscarding the stem 46. The second anchor plate 34 is positioned againstthe cortex of the first metacarpal 12. The suture 32 is tensioned byalternately pulling each strand in small increments until the desiredreduced position of the first metacarpal 12 is achieved. The secondanchor plate 34 is then secured with a multiple surgeon's knot 78.

Following closure of the surgical sites, the joint is splinted. Afterone week, the splint, dressings, and sutures are removed and the firstmetacarpal 12 is splinted with a molded splint in a slightly abductedposition. The splint is discontinued at four weeks post operative andprogressive physical therapy is employed.

Although the invention has been described with reference to thepreferred embodiments, variations and modifications exist within thescope and spirit of the invention as described and defined in thefollowing claims.

The invention claimed is:
 1. An assembly for carpometacarpal fixationcomprising a suture guide including a stem and a first anchor platesecured to the stem by a frangible connection, the first anchor plateincluding a body and a plurality of through holes formed in the body, asecond anchor plate including a plurality of through holes formed in thesecond anchor plate, and a tether engaged with the first anchor plateand the second anchor plate, wherein the first anchor plate includes aterminal end and the stem includes a terminal end, the terminal ends ofthe first anchor plate and the stem separated by the frangibleconnection therebetween, the frangible connection defined by a recessedsurface between the terminal end of the first anchor plate and theterminal end of the stem, wherein the body of the first anchor plateincludes a main portion that surrounds the plurality of through holesand an extension portion extending between the main portion and theterminal end of the first anchor plate, a cross sectional area of theextension portion being smaller than a cross sectional area of the mainportion when each is measured perpendicular to a longitudinal axisthrough the stem, and wherein when the frangible connection is broken,an end of the extension portion remote from the main portion is definedby a beveled end surface.
 2. The assembly of claim 1, wherein the tetheris adjustable to vary a distance between the first anchor plate and thesecond anchor plate.
 3. The assembly of claim 2, wherein the tetherincludes a first loop that is engaged with the second anchor plate withthe first loop extending through a first of the plurality of throughholes in the second anchor plate over a portion of the second anchorplate and through a second of the plurality of through holes in thesecond anchor plate.
 4. The assembly of claim 3, wherein the tetherincludes a second loop that is engaged with the first anchor plate withthe second loop extending through a first of the plurality of throughholes in the first anchor plate over a portion of the first anchor plateand through a second of the plurality of through holes in the firstanchor plate.
 5. The assembly of claim 4, wherein the tether includes athird loop that is engaged with the second anchor plate with the thirdloop extending through a first of the plurality of through holes in thesecond anchor plate over a portion of the second anchor plate andthrough a second of the plurality of through holes in the second plate.6. The assembly of claim 2, wherein the tether includes a first loopthat is engaged with the first anchor plate with the first loopextending through a first of the plurality of through holes in the firstanchor plate over a portion of the first anchor plate and through asecond of the plurality of through holes in the first anchor plate. 7.The assembly of claim 1, wherein, with the first anchor plate and stemfrangibly secured, the first anchor plate and stem are co-linear.
 8. Anassembly for carpometacarpal fixation comprising a suture guideincluding a stem and a first anchor plate secured to the stem by afrangible connection, the first anchor plate including a body and aplurality of through holes formed in the body, a second anchor plateincluding a plurality of through holes formed in the second anchorplate, and a tether engaged with the first anchor plate and the secondanchor plate, wherein the first anchor plate includes a length and awidth, the length of the first anchor plate longer than the width of thefirst anchor plate, wherein the stem includes a length and a width, thelength of the stem longer than the width of the stem, wherein the lengthof the first anchor plate includes an end region and the length of thestem includes an end region, the end region of the first anchor plateand the end region of the stem separated by the frangible connectiontherebetween, the frangible connection defined by a recessed surfacebetween the end region of the first anchor plate and the end region ofthe stem, wherein the body of the first anchor plate includes a mainportion that surrounds the plurality of through holes and an extensionportion extending between the main portion and the frangible connection,wherein a cross sectional area of the extension portion is measuredperpendicular to an axis extending through both the frangible connectionand the main portion, the cross sectional area of the extension portionbeing smaller than a cross sectional area of the main portion measuredperpendicular to a longitudinal axis through the stem, and wherein whenthe frangible connection is broken, an end of the extension portionremote from the main portion is defined by a beveled end surface.